Subdivision Application Form Please be advised that as of November 3, 2021 the Development Officer will require a full legal survey for a subdivision application in Birch Hills County. This application is to be completed in full by the registered owner of the land or by an authorized person acting on behalf of the owner. Please meet with the Planning and Development Department prior to submitting your application. APPLICANT INFORMATIONApplicant Company Email Address TelephoneAlternate TelephoneMailing Address Street Address Town AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Registered Owner(if applicant is other than owner) Company Email Address TelephoneAlternate TelephoneMailing Address Street Address Town AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code LEGAL DESCRIPTION AND AREA OF LAND TO BE SUBDIVIDEDRural/Civic Address or General Location of Project LandLegal DescriptionLot/Block/Plan or Quarter/Section/Twp/RangeArea of the above parcel of land to be subdivided Acres/Hectares Certificate of Title, the application fee includes this cost LOCATION OF LAND TO BE SUBDIVIDEDIs the land situated immediately adjacent to the municipal boundary? Yes No If yes, the adjoining municipality is: Is the land situated within 1.6 kilometers of the right of way of a highway? Yes No If yes, the highway number is: Does the proposed parcel contain or is it bounded by a river, stream, lake, or other body of water or by a drainage ditch or canal? Yes No If yes, state its name: Is the proposed parcel within 1.5 km (1 mile) of a sour gas facility? Yes No EXISTING AND PROPOSED USE OF LAND TO BE SUBDIVIDEDDescribe the existing use of the propertyDescribe the proposed use of the propertyLand use designation in Land Use BylawPHYSICAL CHARACTERISTICS OF LAND TO BE SUBDIVIDEDDescribe the nature of the topography of the land (flat, rolling, steep, mixed)Describe the nature of the vegetation and water on the land (brush, shrubs, tree stands, woodlots, etc. –sloughs, creeks, etc.Describe the kind of soil on the land (sandy, loam, clay, etc.)EXISTING BUILDINGS ON THE LAND TO BE SUBDIVIDEDDescribe any buildings, historical or otherwise, and any structures on the land and whether they are to be demolished or movedWATER AND SEWER SERVICESIf the proposed Subdivision is to be served by other than a water distribution system and a wastewater collection system, describe the manner of providing water and sewage disposalWater Sewer Services RIGHT OF ENTRYI/We, First Last give consent to allow a person(s) designated by the County the right to enter and inspect the above land and/or building(s) with respect to this application only. Signature DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CERTIFICATION AND SIGNATURERegistered owner or person acting on their behalf I, hereby certify that I a) am the registered owner or b) am authorized to act on behalf of the registered owner(s), and that the information given on the form is complete and is, to the best of my knowledge, a true statement of the facts relating to this application. Applicant’s Signature DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920This information is being collected under authority of sections 33(a) and (c) of the Freedom of Information and Protection of Privacy Act. Your personal information will be used to process your application(s). Please be advised that your name, address, and details related to your permit may be included on reports that are available to the public as required or allowed by legislations. All personal information will be managed in compliance with the provisions of the FOIP Act. Questions about the collection of this information can be directed to the Director of Corporate Services 780-694-3793ADDITIONAL APPLICATION REQUIREMENTSThe Subdivision Application must be complete prior to a decision being made. Below is a generalized list of requirements. The Development Officer may require additional information per Land Use Bylaw No. 2019-06depending on the specific nature of the application. Please meet with the Planning and Development Department prior to submitting your application, to review the required information. The application must include the followingCOMPLETED BY APPLICANT Application fee –Please contact the Countyoffice to confirm the applicable fee. The fee must be paid in full at the time of application. Site Plan Report on 8 ½ X 11–all plans must be to scale If the building/addition is greater than 47 m² (505.9 ft²) a map from the Alberta Energy Regulator (AER) identifying the locations of, or confirming the absence of, any abandoned oil or gas wells on or within 25 m (82 ft.) of the site boundary is to be included. Go to www.aer.cafor abandoned well location and status information. Location, dimensions, boundaries and acreage of the land to be subdivided and of each new lot to be created. Significant landfeatures such as ravines, banks, hills, shelterbelts, drainage ditches, railway beds etc. Location of the bed and shore of any river, stream, watercourse, lake or other water body that is contained within or bounds the proposed parcel. Letter of authorization from the registered landowner (if applicant is other than owner). Site Plan Report IncludesCOMPLETED BY APPLICANT north direction arrow legal description, address, property line locations Existing and Proposed water and sewage locations distance from residence to water supply distance from residence to sewage system (where effluent is going) distance from sewage system (where effluent is going) to water supply distance from sewage system (where effluent is going) boundary lines all easements (i.e. utility right-of-way’s) roads, sidewalks, and pathways abutting property Existing and proposed vehicle access to proposed parcel(s) and remainder of the titled area. use and dimensions and location of existing buildings/structures identify any buildings which will be demolished or moved building setbacks building area Site Plan Upload(Required)Max. file size: 256 MB.Additional Attachment UploadMax. file size: 256 MB.